BRONCHITIS AND BRONCHIAL DISEASES.
A cold or catarrh affecting the mucous membrane of the tilt. chea and bronchial tubes; commencing sometimes in a nasal catarrh, and at other times by itself. It is frequently epidemic, but is not contagious. It lasts from three to five days in its acute stage, and, when it begins in the early part of winter or spring, is apt to pass into a long chronic stage. In some persons it be comes a disease of annual occurrence, and is attended with very free secretion of phlegm and troublesome cough. The tendency to bronchial catarrh increases with advance of life.
Inflammation of the mucous tract covering the inner surface of the bronchial tubes. A common affection in this country, and fatal to large numbers of persons. It presents two forms, acute and chronic.
Acute bronchitis arises, in most instances of it, from taking a severe cold, hut it may assume an epidemic form, and from the first be bronchial. There is with it in the earlier stages, chill, depression, a sense of constriction at the chest, difficult breathing, and pain. These signs are followed by fever, and continue until relief is obtained from free secretion of phlegm from the con gested mucous surface. Acute bronchitis is peculiarly dangerous to the young, the old, and the enfeebled of all ages.
Chronic bronchitis is in the ordinary way a sequence and con tinuance of the acute type of the disease. It may nevertheless he developed without the indications of a very acute attack. It is often recurrent in those who have once suffered from it, and probably in this kingdom there are more permanent sufferers from chronic bronchitis than from any other disease whatever. It is attended with constant cough, and an expectoration that is often profuse. In the young it may assume a form so severe as to make it imitate phthisis or consumption, and the term bron chial phthisis has been invented to define that form of disease, recoveries from which have, without doubt, often been mistaken, by ignorants and pretenders in physic, for recoveries from actual or tubercular consumption. Chronic bronchitis is very fatal to the aged, and it tends to become more determinate with increas ing years.
In addition to these ordinary forms of bronchitis there aro other forms in which the disease is induced, as by the inhalation of various vapors, gases, and dusts. It will be shown in a future part, that the affections thus, mechanically, excited run much the same course as when they follow more common causes, and are attended with similar dangers. They are peculiarly fatal to cer tain of our industrial populations.
Some authors have recognized, and I think correctly, a va riety of bronchitis, acute and chronic, of the fine bronchial ramifi cations or capillaries, by which the bronchial tubes communicate with the air vesicles. To this type of the disease the term capil lary bronchitis has been applied. It is a disease intermediate between bronchitis and inflammation of the lung, pneumonia, and it has also been described as pneumonia, under the name of catarrhal pneumonia. It is, in my experience, always sequential to bronchial catarrh or bronchitis, and therefore I venture to place it under the bead of bronchial diseases.
In the bronchial tract there may, finally, be developed various foreign growths; tumors, malignant or cancerous, and non-malig nant; cysts; and, parasitic developments. Occasionally foreign bodies from without are carried into the bronchial tubes and lodge in them.
Bronchial Structural Changes.
The bronchial tubes are subjected to various other changes, of which the following is a brief summary :— IIkeration. A condition in which there is a circumscribed destruction of the mucous lining of the bronchial surface; an ulcer.
Cast deposits. A condition in which a semi-organized deposit of a fibrinous character is laid down on the bronchial mucous sur faces so as to take the cast or shape of the tubes. Such tubular casts are, in some rare instances, coughed up entire.
Necrosis of cartilages. The cartilages of the rings of the windpipe, and even of the large bronchial tubes into which the windpipe bifurcates or divides, may undergo necrosis or local death, under constitutional taint. There are two forms of this affection marked by their respective taints, viz., the syphilitic and the phthisical.
Dilatation and contraction of the bronchial tubes. The bron chial tubes, under long-continued disease, may become generally dilated, or dilated in parts, like the fingers of a glove, with con tracted sections in other parts. The air passing through tubes so changed produces sounds of a blowing, wheezing, or whistling kind, which the person affected, as well as those near, may be able to hear. The dilatations which now and then are caused in the larger bronchial tubes, as a result of long-continued laborious breathing, may be virtually cavities in which large accumulations of secretion are held until they are removed by coughing and expectoration.